Biofeedback may ease chronic constipation

NEW YORK (Reuters Health) - Biofeedback training can have long-lasting benefits in people who suffer from chronic constipation due to a condition called "dyssynergic defecation," new research indicates.

People with this condition have difficulty emptying their bowels because the muscles in their rectum and anus are out of sync. Consequently, when they attempt a bowel movement, their bowels empty incompletely or not all. Biofeedback teaches patients how to get their bowel and anal muscles to work normally to produce a complete and satisfactory evacuation.

Dr. Satish Rao and colleagues at the University of Iowa Hospitals and Clinics in Iowa City, found that biofeedback using sensors monitoring the bowel and anus can indeed help train adults with this type of chronic constipation to have normal bowel movements. While an earlier study by Rao's team showed a benefit at three months, their current study showed benefits lasting out to one year.

Rao, a gastroenterologist, told Reuters Health in a telephone interview that this particular type of chronic constipation has only been recognized over the past 15 years and affects more than 10 million Americans. For unexplained reasons, dyssynergic defecation occurs in twice as many women as men. The condition can interfere with a person's social life and ability to hold down a job.

"Dyssynergic defecation is grossly unrecognized and consequently not well-treated," Rao said. "Many doctors don't know about it or how to manage this problem."

The Iowa team compared the one-year outcome of biofeedback training with standard care in 26 chronically constipated patients with dyssynergic defecation. All of them received standard instruction regarding bowel habits, exercise and breathing techniques, use of laxatives, and the importance of eating a high-fiber diet. They were also encouraged to attempt a bowel movement 30 minutes after eating for five minutes twice a day irrespective of the urge to defecate.

Thirteen of the patients underwent six biofeedback sessions during the first three months and then reinforcing sessions at three-month intervals. During biofeedback training, a probe with sensors is inserted rectally. The sensor detects the muscle signals from the anus and rectum and displays them visually on a TV monitor. While sitting on the toilet, the subjects are able to see how these muscles are contracting or relaxing and with the visual feedback learn how to coordinate them to improve their push movements.

The biofeedback patients had a significant increase in normal bowel movements and normal bowel patterns, whereas no improvement occurred in the 13 control patients who did not receive biofeedback training, the researchers report in the American Journal of Gastroenterology.

In addition, roughly 30 percent of the biofeedback patients stopped taking laxatives, whereas none of the subjects in the control group stopped using laxatives at the one-year point.

In a telephone interview with Reuters Health, Dr. Lin Chang of the David Geffen School of Medicine at University of California, Los Angeles, who was not involved in the study, said these one-year results, coupled with another recent study, suggest that biofeedback is "the treatment of choice" for patients with dyssynergic defecation. The Iowa study, Chang said, "shows that even if you follow a patient who underwent biofeedback out for a year, they all do well as opposed to those who don't get biofeedback."

Chang said biofeedback is not widely used for constipation and only is offered at a few specialized centers because insurance generally won't cover it. According to Rao, fees for biofeedback vary from institution to institution and state to state, ranging from $125 to $600 per session.

Rao is hopeful that controlled studies, such as the Iowa study, will help persuade insurance companies to cover the therapy. "It's so difficult when you see patients who could benefit from biofeedback, but their insurance won't cover it," Rao said.

SOURCE: American Journal of Gastroenterology, online February 23, 2010.

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